Is Bowel Cleansing Necessary Before Colon Surgery?
Is Bowel Cleansing Necessary Before Colon Surgery?
Jung B, Pahlman L, Nystrom PO, et al.
Br J Surg. 2007;94:689-695
To determine the need for mechanical preparation before colon surgery, the authors carried out a randomized trial in every Swedish colorectal center plus a single German center during 1999-2005. A total of 1343 patients with a mean age of 69 years were evaluated. All patients received prophylactic antibiotics, and the groups were nearly evenly divided with respect to use or non-use of mechanical bowel preparation. There were no significant differences in the frequency of cardiovascular, surgical site, or general infectious complications. There was also no difference in the frequency of reoperation (P = .42). At least 1 complication developed in approximately 25% of patients in both groups, and the mortality rate was less than 1% in both groups.
Cleansing the bowel before elective colon surgery has become an established part of preparing a patient for bowel resection. There have been other reports as well as a Cochrane systematic review hinting that this time-honored procedure is unnecessary. Perhaps the results from this large multicenter trial will provide sufficient additional evidence to convince surgeons to abandon this traditional but apparently unnecessary procedure. Patients will certainly welcome the change.
Abstract
Jung B, Pahlman L, Nystrom PO, et al.
Br J Surg. 2007;94:689-695
To determine the need for mechanical preparation before colon surgery, the authors carried out a randomized trial in every Swedish colorectal center plus a single German center during 1999-2005. A total of 1343 patients with a mean age of 69 years were evaluated. All patients received prophylactic antibiotics, and the groups were nearly evenly divided with respect to use or non-use of mechanical bowel preparation. There were no significant differences in the frequency of cardiovascular, surgical site, or general infectious complications. There was also no difference in the frequency of reoperation (P = .42). At least 1 complication developed in approximately 25% of patients in both groups, and the mortality rate was less than 1% in both groups.
Cleansing the bowel before elective colon surgery has become an established part of preparing a patient for bowel resection. There have been other reports as well as a Cochrane systematic review hinting that this time-honored procedure is unnecessary. Perhaps the results from this large multicenter trial will provide sufficient additional evidence to convince surgeons to abandon this traditional but apparently unnecessary procedure. Patients will certainly welcome the change.
Abstract
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